Advance Access: The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy

Surgical Site Infections (SSIs) represent both a significant barrier to patient recovery and burdensome cost to healthcare institutions. Recent studies have indicated that the costs associated with SSIs rank second among all healthcare-associated infections, with approximately $3.3 billion spent annually and over $14 000 per-case.1 SSIs are currently the most frequent hospital-acquired infection, surpassing urinary catheters and central lines,2 and are estimated to account for 31% of all infections among hospitalized patients.3 Moreover, the complications from SSIs cause significant patient distress and jeopardize a full recovery from the initial operation.

It has been suggested that topical application of antimicrobial compounds can reduce complications and costs associated with spine surgeries. Specifically, intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and observed to reduce rates of SSIs significantly.4,–7 Strains of bacteria such as Staphylococcus epidermidis and Staphylococcus aureus, which are associated with SSIs, commonly present in patients as resistance to antibiotics that bind penicillin-binding proteins. These are the same antibiotics typically given intravenously for perioperative infection prophylaxis. Hence, addition of an antimicrobial with a stronger affinity for these resistant species, such as vancomycin, may be more efficacious in reducing SSIs.